Ian McLeod Therapy

OBSESSIVE COMPULSIVE DISORDER

Obsessive Compulsive Disorder (OCD) is a mental health problem suffered by three quarters of a million people in the UK today. The book 'Obsessive-Compulsive Disorder: The Facts' reports that a disproportionately high number of those, about 50% of all these cases, will fall into the severe category with less than a quarter being classed as mild cases (OCD UK).

Obsessions are unwanted, unpleasant thoughts or images that leaves the sufferer feeling distressed. Compulsions are the behaviours the sufferer uses to relieve themselves of the associated distress. Marks (1987) points out that obsessions resemble phobias in 3 ways:

1. As with phobics the relevant evoking stimuli (ES) often induce anxiety, which in Obsessive Compulsive Sufferers (OCS), leads to obsessions and rituals. In both syndromes sufferers may fear harm from contact with the ES.

2. Both phobics and OCS avoid or escape from their ES, and Obsessive Compulsive avoidance can be extensive

3. Both phobic and Obsessive Compulsive syndromes respond well to exposure treatment. It persuades patients to re-enter hitherto avoided situations and to remain in them until ensuing discomfort subsides.

As a typical example, someone who is fearful of personal contamination with germs or infection or who fears infecting other people, will wash their hands repeatedly. They will go to inordinate lengths to avoid 'infection' by, for example, not touching or interacting directly with anything they regard to be 'dirty'. In many cases such 'dirty' items could be unwashed clothing worn just once before, general household rubbish, blood, body fluids, desk or floor surfaces, shoes etc.

A real life example, Moore (1991), was of a young lady who described to her Therapist her goals:

Being able to walk down the street or a park without worrying about what contaminated objects she might walk on

Stop repeatedly washing her hands

Being able to wear her work clothes more than once before having them dry cleaned

Being able to go into supermarkets and other public spaces without worrying about contamination by 'unsavoury looking' people

Containing her fear of blood contamination, for example, if she saw blood on a tissue.

The route to her eventual release was via a multi-faceted approach which included :-

1.A therapeutic dose of clomipramine (175mg nightly) However, in an overview of the pharmacological properties of clomipramine in OCD, McTavish and Benfield (1990) stated that when clomipramine was given with anti-exposure therapy, no drug effect was observed. They also suggested 'In terms of long-term management of obsessive-compulsive disorder, exposure therapy has, on current evidence, an advantage over drug therapy, particularly in compulsive ritualising patients'.

2.Cognitive reframing of her responses to stimuli utilising cognitive behavioural therapy (CBT).

3.Hypnotherapy using de-sensitising exposure therapy to feared stimuli

4.Hypnotherapy using progressive relaxation with 'anchor' to a 'safe place'

5.Hypnotherapy using suggestions to improve her self esteem.

After 12 weeks of weekly therapy sessions, the young lady had successfully achieved her goals but because of the muti faceted approach taken, causality was difficult to attribute. At a 2 month follow up she rated herself at 8 out of 10 and it was agreed that she would slowly taper off clomipramine over the next few months while under regular medical review. At subsequent follow up she rated herself as 9 out of 10 while continuing to taper off clomipramine.

Thus, it can be seen from the example that whilst OCD is a life limiting condition, it is not a life long condition. The message here is clear - the sufferer can be helped and the condition can be treated. It will likely involve a range of treatment options, personal perseverance and courage.

References

Marks, I.M. (1987). Fears phobias and rituals : Panic, anxiety, and their disorders. New York: Oxford University Press.
McTavish, D., & Benfield, P. (1990). Clomipramine: An overview of its pharmacological properties and a review of its therapeutic use in obsessive-compulsive disorder and panic disorder. Drugs, 39, 136-153
Moore, K.A. and Burrows, G.D., (1991). Hypnosis in the treatment of obsessive-compulsive disorder. Australian Journal of Clinical and Experimental Hypnosis, 19(2), pp.63-75.
OCD UK, about OCD, Occurrences of OCD, Available at https://ww.ocduk.org/ocd/how-common-is-ocd/ Accessed 10th April 2024.

If you are struggling to deal with OCD why not contact me? I can help.

Ian McLeod CHP(NC), MNSHP&M, DPLT